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Bullard Laryngoscopy
Which of the following is NOT an indication for use of Bullard laryngoscopy? *A patient with a known failed intubation in the past coming for elective laparoscopy A 42-year-old bearded man is scheduled for an elective laparoscopic cholecystectomy. He is 5'6" tall and weighs 185 lb. He has no history of recent abdominal pain, nausea, vomiting, or reflux. His medical history is significant for rheumatoid arthritis, for which he takes etanercept. Due to the arthritis, he has significant limitation to neck extension and extensive involvement of the TMJ joints, limiting his mouth opening. Because of limited mouth opening, his Mallampati score is III. His thyromental distance is normal, and he has all of hisr native teeth. After the endotracheal tube is repositioned, arterial oxygen saturation and peak inspiratory pressures return to normal, and wheezing subsides. The rest of the case is uneventful. After the drapes are removed, in preparation for emergence, you suction the patient's mouth and note that a large piece of his left upper incisor is missing. There is no dental debris visible in the mouth. The dental fragment is never found. Two days later, you see the patient as he is preparing for discharge home. His surgical recovery has been uneventful, but he states that since the surgery he has had pain on the right side of his throat that he rates as moderate to severe. In fact, it has been the primary reason for his narcotic use for the last 24 hours. He is able to swallow, but his voice is slightly hoarse. He is afebrile. There is no obvious redness or swelling in the oropharynx. On palpation, several cervical lymph nodes can be felt on the right side of his neck, and the area is exquisitely tender. Which of the following actions is the most appropriate to take next? *Request consultation with an ENT specialist. A 42-year-old bearded man is scheduled for an elective laparoscopic cholecystectomy. He is 5'6" tall and weighs 185 lb. He has no history of recent abdominal pain, nausea, vomiting, or reflux. His medical history is significant for rheumatoid arthritis, for which he takes etanercept. Due to the arthritis, he has significant limitation to neck extension and extensive involvement of the TMJ joints, limiting his mouth opening. Because of limited mouth opening, his Mallampati score is III. His thyromental distance is normal, and he has all of his native teeth. Which of the following patient characteristics suggests difficult mask ventilation? *. A 42-year-old bearded man is scheduled for an elective laparoscopic cholecystectomy. He is 5'6" tall and weighs 185 lb. He has no history of recent abdominal pain, nausea, vomiting, or reflux. His medical history is significant for rheumatoid arthritis, for which he takes etanercept. Due to the arthritis, he has significant limitation to neck extension and extensive involvement of the TMJ joints, limiting his mouth opening. Because of limited mouth opening, his Mallampati score is III. His thyromental distance is normal, and he has all of his native teeth. After the endotracheal tube is repositioned, arterial oxygen saturation and peak inspiratory pressures return to normal, and wheezing subsides. The rest of the case is uneventful. After the drapes are removed, in preparation for emergence, you suction the patient's mouth and note that a large piece of his left upper incisor is missing. There is no dental debris visible in the mouth. Which action should you take prior to awakening the patient? *Order an AP chest film. Which mode of intubation has less cervical motion than the Bullard? *Awake topicalized flexible fiberoptic intubation In endotracheal intubation the Bullard has been shown to be as quick as or quicker than: *All of the above A 42-year-old bearded man is scheduled for an elective laparoscopic cholecystectomy. He is 5'6" tall and weighs 185 lb. He has no history of recent abdominal pain, nausea, vomiting, or reflux. His medical history is significant for rheumatoid arthritis, for which he takes etanercept. Due to the arthritis, he has significant limitation to neck extension and extensive involvement of the TMJ joints, limiting his mouth opening. Because of limited mouth opening, his Mallampati score is III. His thyromental distance is normal, and he has all of his native teeth. After induction of general anesthesia, the Bullard laryngoscope is used to place a 6.5 endotracheal tube without apparent difficulty. The tube is taped 23 cm at the teeth, and there is CO2 on the end-tidal gas monitor. Shortly after intubation, the patient's arterial oxygen saturation falls to 89%, and the peak inspiratory pressure rises to 45 cm H2O. Which of the following would be best to do next? *Untape the endotracheal tube and withdraw it at least 2 cm.